FACTORS INFLUENCING OCCUPATIONAL HEALTH AND SAFETY

PRACTICES IN THE PRIVATE HOSPITALS IN MOMBASA ISLAND

BY

GIBSON MNYIKA MWAWASI

UNitfERSM V Ut~ fUAirv'Ud KIKUYU LIBRARY

0. Box 30197 m a j p o p ’

A RESEARCH PROJECT REPORT SUBMITTED IN PARTIAL

FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF A

MASTER OF ARTS DEGREE IN PROJECT PLANNING AND

MANAGEMENT OF THE UNIVERSITY OF NAIROBI

2012

DECLARATION

This research project report is my original work and has never been presented for award o f a

degree in any other university

GIBSON MNYIKA MWAWASI

REG: L50/60644/2011

The research project report has been submitted with my approval as a university of Nairobi

supervisor

tSITV OF NAIROBIi EDUCATION

.g p * .83732-80100

TEL: 0202026100DR. MOSES O ' ^ p O

LECTURER

DEPARTMENT OF EXTRA MURAL STUDIES

UNIVERSITY OF NAIROBI

u

DEDICATION

This research project report is dedicated to my wife Deborah, my two lovely daughters Defrodah

and Fridah and my son Mzee Sabiti as a sign of love towards them.

ACKNOWLEDGEMENT

Quite a number o f people have helped me as I was through the process o f completing my report

Special thanks to Dr. Moses Otieno who is my project supervisor for his special direction and

guidance as 1 was struggling to accomplish this research proposal.

Many thanks also go to my lecturers on various subjects who gave me the knowledge to write

this project

Finally, 1 would like to thank my wife Deborah for her encouragement and understanding while I

was attending the course

IV

LIST OF TABLES

PAGE

Table 3 .1 -T arg e t population....................................................................................................... 31

Table 3.2 - distribution of staff per cadre.................................................................................. 32

Table 3.3- Sampling fram e.......................................................................................................... 34

Table 4.2 - Distribution o f employees........................................................................................ 41

Table 4.3 - Demographic characteristics o f respondents........................................................ 41

Table 4.4 - Levels o f education of staff.................................................................................... 42

Table 4.5 - Attendance o f education and training on health and safety............................... 43

Table 4.6 - Existence of health and safety program................................................................ 44

Table 4.7 - Presence of safety instructions and warnings...................................................... 44

Table 4.8 - Environment and ergonomics................................................................................. 45

Table 4.10.1.0: -Levels o f Education and knowledge occupational heath and safety ... 47

Table 4.10.1.1: -Frequency o f levels o f Education and knowledge occupational

heath and sa fe ty .................................................................................................. 47

Table 4.10.1.2: -Expected frequency o f levels o f Education and knowledge

occupational heath and safe ty ........................................................................... 48

Table 4.10.2.0: -Frequency on existence o f heath and safety programs............................. 49

Table 4.10.2.1: -Expected Frequency on existence of heath and safety program s.......... 49

Table 4.10.2.2: -C hi square calculated 2 ................................................................................... 50

Table 4.10.3.0: -Frequency o f opinion from staff about the environment and

ergonom ics......................................................................................................... 51

Table 4.10.3.1: -Expected Frequency o f opinion about the environment and ergonomics . 51

Table 4.10.3.2: -C hi square calculated 3 ...................................................................................... 52

Table 4.10.4.0: -Opinion about accidents.................................................................................. 53

Table 4.10.4.1: -Expected Frequency about influence on accidents........................................53

Table 4.10.4.2.: -C hi square calculated 4 ................................................................................... 54

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LIST OF FIGURE

PAGE

Figure 1 Conceptual Framework............................................................................... 29

VI

LIST OF ABBREVIATIO NS

OSH - Occupational safety and health

HIV — Human Immuno Deficiency Virus

AIDS — Acquired Immuno Deficiency Syndrome

ABSTRACT

The objectives o f the research were to determine the factors that influence occupational safety and health practices at the private hospital in Mombasa Island, the contribution o f health and safety measures o f working environment and also assess the impact o f work environment as on working conditions and the effects o f health care workers and to develop a theoretical framework to explain relationships involved. The importance o f health and safety is demonstrated by the cost of compliance in terms of job related injuries and workers compensation as well as absence from duty. The study has explored how to improve the attitudes towards safety by both the administration and the employees. It has identified health and safety practices, current situation and preventive measures that should be taken to improve the situation. The success by any organization depends largely on the constant reinforcement and review o f health and safety measures. The virtual aspect is to keep the employees’ health and safety. The research involved review o f literature on occupational health and safety from various books which concluded that effective health and safety policy and programs are vital and a legal requirement for any organization with more than five employees. The study involved various statistical analyses on both secondary and primary data obtained from three hospitals in Mombasa Island whose bed capacity is more than eighty. Qualitative data was obtained from about 50% o f the staff in each hospital using a self administered questionnaire followed by a proportionate stratified sampling to ensure representation of all cadres since the population is heterogeneous. Interview and observation guide were also used during the study. The result o f the study demonstrates that there is adequate provision o f facilities in the hospitals. However there are no health and safety programs in place .The hospitals do not have a clear strategy and commitment to health and safety. It was also established that the environment and ergonomics is also good in those hospitals. In addition it was found out that most o f the employees are literate and hence could read and understand safety rules and regulations, but majority have not undergone any training. It was also established that the hospitals do not keep records o f accidents and no investigation on causes o f accidents were kept if any occurred. The research recommends that training o f health and safety should be mandatory at recruitment and when risk change. This can be done through seminars, workshops, meetings and on job training. The management should ensure provision of enough protective equipment, devices and clothing to safeguard against hazard and ill health. The research makes suggestion that a similar study is conducted in government aided hospitals and also a risk assessment is carried out in the private hospitals.

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TABLE OF CO NTENTS

CONTENTS PAGE

DECLARATION....................................................................................................................... II

DEDICATION............................................................................................................................ I ll

ACKNOWLEDGEMENTS................................................................................................... IV

LIST OF TABLES.................................................................................................................... V

LIST OF FIGURES................................................................................................................... VI

ABBREVIATIONS AND ACRONYMS............................................................................. VII

ABSTRACT.................................................................................................................................. VIII

CHAPTER ONE: INTRODUCTION

1.1 Background o f the S tudy ..................

1.2 Statement o f the problem ..................

1.3 Purpose o f the Study...........................

1.4 Objectives o f the study................................................. *t.......................

1.5 Research Q uestions.............................................................

1.6 Research H ypothesis.......................

1.7 Significance o f the s tudy ................

1.8 Delimitations o f the study (scope o f the study).........

1.9 Limitations o f the study .................................................

1.10 Basic Assumptions of the S tudy ...............................

1.11 Definition o f significant terms as used in the study

1.12 Structure o f the report .................................................

......: 1 A

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CHAPTER TWO: LITERATURE REVIEW

2.1 Introduction.......................................................................................................................... 8

2.2 Review o f Related Literature............................................................................................ 9

2.2.1 Working environment, health and safety at work.................................................... 9

2.2.2 Determinants o f health and safety............................................................................. 11

2.2.3 Importance o f health and safety................................................................................. 12

2.2.4 Health and safety policy and its importance............................................................. 12

2.2.5 Health and safety programmes.................................................................................... 14

2.2.6 Management of health and safety programs....................................................... 15

2.2.7 Role of the management......................................................................................... 16

2.2.8 Safety representatives.............................................................................................. 16

22.9 Safety committees................................................................................................... 17

2.2.10 Management o f health and safety......................................................................... 18

2.2.11 External inspections................................................................................................. 19

2.2.12 Accidents and their causes..................................................................................... 19

2.2.13 Accidents proneness................................................................................................ 20

2.2.14 Risk assessment / health and safety audits............................................................ 21

2.2.15 Safety inspections...................................................................................................... 21

2.2.16 Preventive measures o f accidents / accidents report............................................ 21

2.2.17 Compensation for accidents at work..................................................................... 22

2.2.18 Legal requirement regarding health and safety..................................................... 23

2.2.19 Health and safety education and training............................................................. 27

2.3 Conceptual Framework................................................................................................. 28

2.4 Summary o f Literature.................................................................................................. 30

CHAPTER THREE: RESEARCH METHODOLOGY

3.1 Introduction.......................................................................................................................... 31

3.2 Research Design.................................................................................................................. 31

3 .3 Target Population.............................................................................................................. 31

3.4 Sample Size and Sampling Procedure............................................................................. 31

3.5 Data Collection Methods................................................................................................... 34

3.6 Data Collection Procedure................................................................................................. 35

3.7 Validity and Reliability o f Research instruments.......................................................... 36

3.8 Ethical Considerations (optimal)...................................................................................... 36

3.9 Data Presentation and Analysis techniques.................................................................... 37

3.10 Operational Definition o f Variables.............................................................................. 38

CHAPTER FOUR: DATA ANALYSIS, PRESENTATION AND INTERPRETATION

4.1 Introduction......................................................................................................................... 39

4.2 Distribution o f employee at the hospitals....................................................................... 39

4.3 Level o f education.............................................................................................................. 41

4.4 management o f health and safety programs.................................................................. 42

4.5 Legal requirements regarding to health and safety........................................................ 43

4.6 working environment and ergonomics............................................................................... 44

4.7 Managements commitments towards health and safety............................................. 45

4.8 hypothesis testing................................................................................................................ 46

CHAPTER FIVE: SUMMARY OF FINDINGS, DISCUSSION, CONCLUSION-

AND RECOMMENDATIONS

5.1 Introduction.......................................................................................................................... 53

5.2 Summary o f findings........................................................................................................... 53

5.3 Conclusion............................................................................................................................. 54

5.4 Recommendations............................................................................................................... 55

5.5 Suggested Areas for further research................................................................................ 56

REFERENCES......................................................................................................................... 57

APPENDICES

Appendix I: Letter o f Transmittal.......................................................................................... 59

Appendix 2: Q uestionnaire................................................................................................. 60

Appendix 3: Interview gu ide .............................................................................................. 64

Appendix 4: Observation g u id e ........................................................................................ 64

C H A PT E R O NE

IN T R O D U C T IO N

1.1. Background of the Study

Occupational safety and health (OSH) is concerned with protecting safety, health and welfare

of people engaged in work or employment. The goal o f occupational safety and health

programme is to foster a safe and health working environment. As a secondary effect OSH

may protect co-workers, family members, employers, customers, suppliers, nearby

communities and other members o f the public who are impacted by the work place

environment as well as reduce medical care, sick leave and disability benefit cost.

Originally hospitals meant a place where strangers or visitors were received; in the course of

time, its use was restricted to institutions for the care of the sick. A hospital is a health care

institution providing patient treatment by specialized staff and equipment. During the middle

ages hospitals served different functions to modem institutions being almshouses for the

poor, hostels for pilgrims or hospital schools. They are usually funded by public sector

comma, by health organizations (for profit or non profit), health insurance companies or

charities including direct charitable donations. Historically hospitals were often founded and

funded by the religious or charitable individuals and leaders. Today hospitals are largely

staffed by professional physicians, surgeons and nurses, whereas in the past the work was

usually performed by founding religious holders or by volunteers. There are about 17,000

hospitals in the world. In Kenya there are three hundred and twenty. Mombasa County alone

has twenty four hospitals out of which eight are sponsored by the government. The rest are

privately owned by communities, individuals and churches. For the purpose of this study, we

will concentrate on the major private hospitals with bed capacity of over eighty. This includes

Aga khan Hospital-Mombasa. Mombasa Hospital and Pandya Memorial hospital.

The overall aim of the study is an evaluation of Health and Safety practice at the main private

hospitals in Mombasa county. Also to assess the impact of health and safety on the workers at

those hospitals.

On both ethical and legal grounds, the safety of all employees affected by an organization's

operations must be of major concern of every one employed in an organization and the

management.

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Health and safety at work act (1974), provides the basic framework in setting the basic

principles and duties on those involved. Ever) employer should ensure the Health and safety

at work for all employees. Every employee must take reasonable care at work, personal safety

and that of others, and must co-operate with the employer on matters related to safety.

Standards of health and safety are not fixed, since the act frequently uses the phrases “as is

reasonable", to qualify its provisions.

With innovation in safe procedures and new awareness of hazards, what may be acceptable

and practicable in one area may be seen a hazardous and unacceptable in another.

Injuries inflicted by the system of work or working conditions cause loss and suffering to

individual's employees and their dependants. Accidents and absence through ill health result

in losses and damage to the organization. It is hoped that this research will provide useful

guidelines for the management and workers at Pandya Memorial hospital to formulate viable

policies and procedures on Health and safety, increase training for staff on Health and safety

practices etc.

1.2. Statement of the Problem

Work plays a central role in people’s life, since most workers spend at least eight hours a day

in the work place. Therefore work environment should be safe and health. This is not yet the

case for workers of the private hospitals in Mombasa Island.

Everyday workers in all this hospitals are faced with a multitude of health hazards such as

exposure to occupational diseases such as Tuberculosis, HIV (AIDS) and other

communicable diseases. With various medical activities that take place at those hospitals both

medical and non medical staff at those facilities are exposed to hazardous and risky

conditions, handling of hospital waste materials, exposure to radio active rays in the x-ray

department, overcrowded words due to shortage of wards due to shortage o f wards, poor

sanitation, poor ventilation coupled with improper hospital waste disposal means that staff in

the hospital are exposed to numerous hazards and hospital waste obnoxious smell pollution.

Toilets in the wards are not clean, the kitchen floor is slippery, hence the institution is

characterized by inadequate working facilities, equipment and poor health and safety

practice. Unfortunately some of the hospital management assumes little responsibilities for

protection of the workers health and safety. Infact, some of management do not even know

that they have a moral and often legal responsibility to protect the workers. It is the intention

of the research to evaluate the health and safety practices o f staff in the hospital, consider the

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health and safety policies and programs in place and the extent to which these are practically

applicable, how effective they are and suggest possible solutions for improvement.

Healthy and safety in hospitals has been compromised because, although it is a legal

requirement, those hospitals that flout it are not prosecuted for lack of proper enforcement.

This study therefore seeks to re-emphasize the importance o f Health and safety program and

evaluate the health and safety practices of staff in Pandya Memorial hospital in order to

provide practical case study information on how the institution are responding to this

important requirement.

In nutshell the study will provide a basis upon which improvement in enforcement, of health

and safety practices can be developed at the main private hospitals in Mombasa county and

also serve as a reminder to the hospital administration o f their moral and legal obligation

towards delivering an effective health and safety programme in order to protect the lives and

health of their staff and clients.

Finally but not the least, the study will help the organization to understand the fact that it is

cheaper to develop viable Health and safety programmes than meet the costs like

compensation for injuries inflicted, legal fees and other requirements.

U Purpose of the Study

The purpose o f this study was to examine factors influencing occupational, health and safety

practices in the Private Hospitals in the Mombasa Island.

1.4 Objectives of the Study

In order to improve health and safety practices at the private hospitals in Mombasa Island the

survey is undertaken with the following objectives;

i. To establish the extent to which legal requirements regarding health and safety at

work, influence self and health practices at the private hospitals in Mombasa

Island.

ii. To establish the extent to which management o f health and safety programme and

safety committees influence Health and Safety Practices at the private hospitals in

Mombasa Island.

iii. To establish the extent to which working environment influence health and safety

practices at the private hospitals in Mombasa Island.

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iv. To establish the extent to which health and safety education or awareness

influence health and safety practices at the private hospitals in Mombasa Island.

v. To establish the extent to which accidents and health and safety programmes

influence health and safety practices at the private hospitals in Mombasa Island.

1.5 Research Questions

The research aimed at trying to answer the following questions;

i. To what extent do the legal requirements; Employment act. Workman's compensation

act and Health and Safety at Work Act influence health and safety practices at the

private hospitals in Mombasa Island?

ii. How does the management o f health and safety programmes and safety committees

influence health and safety practices at the private hospitals in Mombasa Island?

iii. How does the work environment influence health and safety practices at the private

hospitals in Mombasa Island?

iv. How does health and safety education, training and awareness influence health and

safety practices at the private hospitals in Mombasa Island?

v. How does accidents influence health and safety practices at the private hospitals in

Mombasa Island?

1.6 HYPOTHESIS

The following hypothesis were utilized for the study. The first hypothesis

1. Ho: Legal requirements are not effective in influencing the health and safety practices

in hospitals.

Hi: Legal requirements are effective in influencing the health and safety practices in

hospitals.

2. Ho: There is no different in attitude on existence o f health and safety programs in the

private hospitals in Mombasa Island.

Hi: There is different in attitude on existence of health and safety programs in the

private hospitals in Mombasa Island.

3. Ho: The environment has no effect on health and safety practices in the private

hospitals in Mombasa Island.

Hi: The environment has effect on health and safety practices in the private hospitals

in Mombasa Island.

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4. Ho: Hospitals workers knowledge of occupational health and safety differ significant

among the private hospitals in Mombasa Island.

Hi: Hospitals workers knowledge of occupational health and safety does not differ

significant among the private hospitals in Mombasa Island.

5. Ho: Accidents influence health and safety practices in private hospitals in Mombasa

area.

Hi: Accidents influence health and safety practices in private hospitals in Mombasa

area.

1.7 Significance of The Study

The follow ing were significance of the study;

i. The employees of the private hospital will benefit from more effective Health and

safety programs

ii. The study will encourage Pandya Memorial Hospital Administration to conduct a

critical review o f the existing Health and safety practices and programs with a

view to making them more effective.

iii. The study will have an overview on how workable and effective Health and safety

programs should look like.

iv. The study will give the researcher a better understanding of health and safety

issues in organizations generally. It is also an important part requirement for the

aware of Masters Degree in Project Planning and management, which he is

currently undertaking

v. The research will also form a basis of reference for other Researchers.

1.8 Delimitation OfThe Study

The study will focused on the factors that influence health and safety practices at the

private hospitals in Mombasa County.

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1.9 Limitations Of The Study

The study faced the following challenges;

i. Confidentiality o f sensitive information may prevented the researcher from

accessing files and literature which may provide more information on past

accidents, their causes and subsequent action in order to deal with this, the

researcher will do observation on various issues and relied on verbal information.

ii. Funds were not inadequate in facilitating data collection, traveling and report

writing since this required engagement of research assistants at least two. The

researcher borrow money from his cooperative to meet the costs.

iii. The researcher was not able to interview all the staff, because they work on shifts

and those who work during the night were not interviewed directly. The

researcher however left questionnaires with the Hospital Administrator to give

them out to the night shift staff.

iv. Lack of co-operation by some of the employees limited access to information

required for the research. The researcher tried to persuade the employees to fill the

questionnaire by first having a session to sensitize them before giving them the

questionnaires.

v. The researcher was prompted to zero down due to time pressure, as the time was

too short to gather enough information for the research. However the researcher

sampled the population.

1.10 Basic Assumptions of the study

Though Health and Safety programs protect employees from illness, minimize

probabilities of accidents. It was assumed that:-

i. The current health and safety programs remained in force during the period of the

research

ii. The same management remained in place and did not change before or during the

research. Co-operation from the management was to be there and would not deter

the research

iii. The then legislation on health and safety did not change before or during the

research.

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1.11 Definition o f significant terms

Assessment: Refers to deciding and fixing the value or quality o f something

Hazard: A written guide or plan o f action for use by management and supervisors in

order that they reach the organizations' objectives following set broad patterns o f

behavior

Health: A state o f complete physical, mental and social well being and not merely the

chance o f disease or infirmity. It is an employee’s freedom from physical, mental or

emotional illness.

Health and Safety Audit: Provide more comprehensive review o f all aspect of

Health and Safety policies, procedures and practice programs.

Health Education: The program that emphasize personal choice and lifestyle and

individual behavior change

Program: Is a sequence of activities designed to implement policies or objectives. It

gives a step by step guide for action necessary to reach a predetermined goal.

Risk: The chance, large or small o f harm actually being done by hazard

Risk Assessment: Identify specific Hazards and qualify o f the risk attached to them

Safety: Refers to the quality or state o f being free from danger

Safety Inspection: Examine specific areas o f organizational operation in order to

locate and define any faults in the system, equipment, plant or m achine or any

operational errors.

1.12 STRUCTURE OF THE REPORT

The study is on factors influencing occupational health and safety practices in private

hospitals in Mombasa island. It is divided into five chapters excluding the declaration,

dedication, acknowledgement, abbreviation and acronyms, abstract, references and

appendices. Chapter one introduces the subject and explain the problem, purpose,

objectives, research questions, hypothesis, significance, limitations and assumptions

o f the study, it also define significant terns used. Chapter two is on literature review

o f the subject and concludes with a conceptual framework o f the topic. Chapter three

is on the methodology used. It explains the research design, target population, sample

and sampling techniques and how data was collected and validated, it also explains

the ethical considerations and operational definition o f variables. Chapter four is on

data analysis and presentation. Chapter five explains the summary o f findings,

discussion , conclusion, recommendations and suggested areas for further research.

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CHAPTER TWO

LITERATURE REVIEW2.1 Introduction

Occupational health and safety aim at promotion and maintenance of the highest degree of

physical, mental and social well being of the workers in all occupations. It also aims at

prevention among workers o f adverse effects of health caused by their working conditions, it

also aims at protecting of workers in their employment from risks resulting from factors

adverse to health and placing the maintenance of workers in an occupational environment

adopted to physical and mental needs. Finally it aims at the adaptation of worked to humans.

In other words occupational health and safety encompasses the social, mental and physical

well being of workers that is the “whole person”

In this chapter various factors and matters on Occupational Health and safety practices of

employees in an organization are to be reviewed as per the different scholars, who have

researched and written books about the subject. It also includes the contribution o f Health and

safety practices on employees' performance, the impact of Health and safety on employees. It

covers among others, working conditions, Health and safety practices, employee welfare

together with relevant statutory and common law provisions on matters of Health and safety

at work environment.

The following sub-heading are to be covered on evaluating the Health and safety practices at

work place:

a. Working environment, health and safety at work

b. Health and safety policy and its importance

c. Components of a health and safety programme

i) Management

ii) Safety committees

iii) Safety representatives

d. Accidents at work

i) Causes o f accidents

ii) Risk Assessment

iii) Safety inspections and audits

iv) Costs involved in accidents

v) Preventive measures of accidents

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vi) Accident reports

vii) Compensation for accidents at work

e. Legal requirements regarding Health and safety at work

f. Health and safety education and training

2.2 Review of related literature

2.2.1 Working environment, health and safety at work

According to Strawa and Sayles (1980) until recent years, managers generally considered

employees Health and Safety relatively a minor concern. The dark, dirty, dangerous

workshops on the early days of industrial revolution were history. Tools and factories has

been redesigned, safety equipment had been introduced and workers were bombarded with

warnings to work safely.

The modem places was considered a good place to work, but now this complacency has been

shattered by rising accidents statistics and the discovery that, many materials used in

manufacturing pose long term threats to health. Employee Health and safety today is a

complex, multidimensional problem according to the world Health Organization (WHO),

Health is a state of complete physical and social well-being and not merely the absence of

diseases or infirmity.

It is an employee's freedom from physical. Mental or Emotional illness. Health and Safety at

work go hand in hand. Safety thus is the protection of employee’s from injuries due to work

related accidents.

According to the WHO (1986) a healthy work place is:-

a. A place where health risks are recognized and controlled if they cannot be removed.

b. A place where design is compatible to people, Health needs and limitations

c. An environment that support protection of health styles

d. A place where employees and employers recognize their responsibility for their health

and health by the colleagues.

Modem industrial society creates conditions in which it all too easy their people to become

victims of hazardous and stressful events at work. Certain environment hazards impinge on

our sense for example, an intolerable level of noise could be the cause of acute discomfort

and eventually lead to deafness. Doctors and nurses may suffer ill health from handling of

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patients suffering from communicable disease like Tuberculosis (TB), HIV / AIDS, Typhoid

etc. lab technologist may suffer discomfort from X-rays emitted from XOrays machines.

Workers in the kitchen may suffer due to slip and injure her / him

According to British safety council (1994), factors which affect health of workers can be

divided into two groups namely:-

a. Those which can associate with his working environment

b. Those which he/she shares with the rest of the community.

As regards to factors that are shared by the community, it seems reasonable to hold that

workers should have the facilities for health protection that the state provides, but as regards

the factors in working environment, which tend to provide ill health to workers has s right to

demand special measure for protection i.e. preventive and curative health service, hence

according to chair (1999) a work[ place can contribute significantly to promoting wider

public health objective across the country. Health and safety cost money, but money alone

cannot buy them. Clearly organizations that constantly have fewer accidents are willing to

pay substantial cost of constant educational programs, surveillance, equipment modifications

and research.

They avoid the easy management view that after all, a certain number of accidents are

inevitable, particularly in hazardous work. Health is one o f the rights for all people. The

development o f service to promote health is party of the battle against the scourges of

poverty, ignorance and diseases.

According to Smith and Jackson (1988), the aim of health service is to provide medical care

both preventive and curative, and the attainment of highest standard of health is one being

without discrimination in terms of race, religion, political. Economic and or social condition.

In broad term. Health is concerned with the effect that work may have effect on the people or

lack of it may have on their ability to work

According to Wood (1983) the emphasis on positive health is the cornerstone of all health

education activities and involves the process of enabling individuals and communities to

increase control over the determinants of health and therefore improve their health

According to NZUVE (1990. Health is the employees freedom from physical or emotional

illness while safety is the protection o f employees from injuries due to work related accidents

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According to AMSTRONG (1999) Health and safety policies and program are concerned

with protecting employees and other people affected by what the company produces and does

against the hazards arising from their employment or their links with the company.

2.2.2 Determinants of health and safety

According to CASCIO (1981), the factors which determine Health and safety in

organizations are:-

a. Nature of the job. Some jobs are more hazardous than others e.g. coal mining

compared to office work.

b. Employee's attitude. Some employees resist the safety measure instituted by the

management for example, refusal to wear protective clothing, refusal to carry out

an extra safety procedures, others simply reckless.

c. Manager’s goal and commitment. Employers that are committed to the Health and

Safety of their employees are ready to adopt measures towards this end.

d. Profitability. Some employers, however are more interested in making profits than

how it is made, therefore do not bother about Health and Safety of their workers.

e. Other Employers do see and appreciate the need to safeguard their workers but

their financial positions cannot allow them to carry - out adequate Health and

Safety programs.

f. Type of technology according to SAYLES (1981) is also a factor for example,

high speed equipment, laser and radiation

Health and safety determines are thus driven by biological, environmental, ecological factors,

by lifestyles and behavioral variables and by people perception of the controlled by socio­

economic and political influences. The practice of occupational health does not occur in a

vacuum, it has context and links with other over arching factors.

According to COMPENHAGEN (1998), social determinants are the key to reducing health

inequalities

Industrialization has brought with it many occupational disease and injuries arising from poor

working conditions, environmental as stated above, pollution, ignorance at work place.

Health and safety, poor management and organization at work

According to STRAWS and SAYLES (1980) Health and safety in an organization can be

determined by the following:

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a. Type of the industry. Some occupations are more hazardous than others depending

on the size of the firm.

b. Management attitude. Management policies and efforts also make a difference

c. Technology - Modem technology uses high-speed equipment, more lasers and

radiation and a variety o f organic chemicals and plastics.

d. Employee can create accidents, however it is difficult to separate human from

technological causes.

2.2.3 Importance of health and safety

According to GUPTA (1996), Health and safety in an organization is important because:-

a. It maintains and improves productivity and quality of work

b. Minimizes absenteeism and labor turnover

c. Reduces industrial unrest, indiscipline and accidents

d. Improves employee motivation and morale

e. Reduces spoilage and cost operations

f. Preserves the physical and mental Health of Employees

AMRSTRONG (2000) argues that. Health and safety in an organization is important in that:-

a. Elimination or minimization of Health and safety risks and hazards is a moral as

well as legal responsibility of employers

b. Health and injuries inflicted or caused by systems or work or working

conditions cause suffering and loss to individuals and their dependants

c. Accidents and absences thorough ill health or injuries result in losses and

damages to the organization

According to BETTS (1980) some o f the losses are

a. Costs of damaged equipment, machines and plant.

b. Cost of wages for time lost by injured workers

c. Cost of supervisors and staff in investigating, recording and reporting accidents

d. Costs of replacing injured employees.

e. Poor employee health leads to high level o f absenteeism and low level of

productivity

GRAHAM 1998) agree with him by saying that the cost o f accidents at work is enormous,

both in Human suffering and lost production.

12

2.2.4 Health and safety policy and its importance

According to BL'RCHILL and CASEY (1996), any firm employing more that four workers

is legally obliged to prepare a written statement o f its Health and safety and bring this to all

employees attention.

The statement should contain a description of the firms' safety organization (e.g name of

company safety officers, union representatives, and information about the safety committees

and details of specific alarm systems, procedures for reporting accidents, facilities and safety

training.

According to NAYULOR (1996), Health and safety at work act requires that a safety policy

be published and that there should be programmes of instruction and training to ensure its

compliment. Typical company safety policies reiterate the general principles of the act

expressing them in the companies' context. They should set out how Health and safety will

be promoted, planned and controlled within the section. Here safety problems are addressed

through a process of continuous improvement. There is a legal requirement to record all

accident resulting to loss o f work time and other hazards, hence reduce the incidence or

impact.

According to COLE (2000), every employer with more than five (5) employees is required to

prepare and keep an up to date written statement of the safety policy. This he adds reflects the

employee's commitment to safety and Health at work. It should also indicate what standards

of behavior are aimed at in Health and Safety. The policy statement should be drawn to the

attention of all employees.

According to PRAFT AND BENETH (1978), all employees except for those with less than

five employees are required to formulate and publish a written statement of general policy for

Health and safety of employees. Provision is also made fro policies to be regularly revised

and such be communicated to staff. He further points out that in the formulation of the policy

the following guideline should be published:-

a. The statement should lay down broad policy principles which should then be

elaborated and interpreted as appropriate for the needs of various organizational

levels and location.

b. The statement should make clear the importance of health and safety precaution

and the role of all employees in maintaining a safe and healthy working

environment.

c. The statement should declare the employer's intention to provide the safest and

healthiest working conditions possible.

13

d. Rules and regulations of specific hazards should be stated. Details of ways of

dealing with other common hazards such as machines safety guards and protective

clothing should be included.

e. The statement should identify the officer responsible for the fulfillment of the

policy together with others responsible for implementing the policy.

f. A description of point consultative committee for health and safety should be

included together with others who are members o f such committees.

g. Management intention to achieve a healthy and safe environment through training

and effective supervision should be emphasized together with management

proposal to achieve such ends

h. Procedures for further for further reporting and recording of accidents should be

described together with arrangement for the analysis and communication of

accidents date to management and safety committees.

2.2.5 Health and safety programmes

Health and safety programs are concerned with:-

a. Guiding the organizations management on plans of action and how the safety

objectives can be met

b. Protecting employees and other people affected by what the organization or

company procedures and does against the hazards, either from their employment

or their links with the company

c. Helping to eradicate or minimize accident occurrence and production cost

brought about by accidents.

d. Declaring the intent of the management to protect employees and how to realize

the intents.

According to ARMSTRONG (2000) occupational Health programs deal with the prevention

of ill health arising from the working condition.

He further says that an effective Health and safety program should include the following:-

a. Conducting of risk assessment which identify hazards and assess the risks

attached to them.

b. Carrying out of Health and safety audits and inspections

c. Implementing of Health and safety audits and inspections

d. Management of stress

e. Prevention of accidents

14

f. Measuring of Health and safety performance

g. Communicating the need for good Health and safety practices

h. Training in good Health and safety practices

i. Organizing health and safety'

j. ZAYLES(1981) state that good Health and safety programs include:-

k. Safety training and

l. Inspection and discipline o f careless employees

m. Control of the work environment SCHEER (1997) argues that a successful

safety program must be;-

n. Planned to fit the needs o f operations

o. Organized to encourage willing participation

p. Administered with support and dedication

q. Stimulated to perpetuate interest and enthusiasm

r. Evaluated to encompass ideas and methods

s. The programs should contain safety rules (written, practical reflecting on unsafe

acts or conduct), safety meetings, safety training and Education, accident

prevention, safety inspections, safety records on frequency and severity of

accidents and safety committees.

2.2.6 Management of health and safety programs

(a) Employees

According to NAYLOR (1996), every employee must, at work take reasonable care for his or

her own, safety and that of others and must co-operate with the employer on matters related

to safety.

(b) Employer

According to BETITS (1983), it is a duty of every employer to ensure so far as reasonably

practical Health and safety and welfare at work for all employees.

a. Provision and maintenance of plant and sytems of work that are as far as is

reasonably practical safe and without risks to health

b. Provision of such information, instructions, training and supervisdon is

necessary to ensure Health and safety of employees at work

c. Provision and maintenance of a working environment

d. The role of the employers according to ATLOR (1996) is to:

15

e. Produce a statement of general safety policy and how it is to be implemented

and distributed to all employees.

f. Ensure that work places, their plant and process are safe and do not have health

risk

g. Provide safe means of entry and exit

h. Instruct, supervise and train all employees in good Health and safety practices in

work place

i. Consult with, according to published code of practice, employee representatives

j. Ensure that persons who are employed are given information on safety and

hazards, both in relation to their working within the premises.

2.2.7 Role of the management.

According to BETTTS (1983), the management of an organization has the following role to

play in implementing a Health and safety program

a. To issue a written statement of safety policy

b. To establish an organization and allocate responsibilities for Health and safety

maters

c. To train members of the company in health and safety matters

d. To establish a safety committee

e. To ensure that first aid facilities exist

f. To provide appropriate procedures and documents to minimize accidents

g. To consult with safety representatives appointed under the safety

representative regulations with a view to making and maintaining

arrangement which promote and develop measure for safety and Health of

Employees and checking the effectiveness o f such measures

2.2.8 Safety representatives

According to BURCHILL and CASEY (1996). states that in consequence of the Health and

safety at work place act 1974, if a firm recognizes a trade union, then if the union so wishes it

may safety representatives at the place of work.

The role of safety representatives are:-

a. To investigate accidents and dangerous occurrences

b. To inspect the work place every 3 months or following as approaches accident

or near accident

16

c. To make representations to the management on safety matters.

He further argues that safety representatives are entitled to copies of any relevant information

on accidents; Departmental managers are obliged to accompany the representatives during

inspections.

Notice of an inspection need not be given if an accident has just occurred, and that safety

representatives are entitled to: reasonable facilities” for undertaking inspections COLE

(1997) further argues that as part of general intention to increase the involvement of ordinary

employees in safety and health matters, the 1974 Act provides fore regulations to be made

concerning the appointment of safety representatives amongst employees in cases where an

independent trade union is recognized by the management. The safety representatives and

safety committees regulations 1877 gives the functions of the representatives as follows:-

a. To investigate potential hazards, dangerous concurrencies, and to examine the

causes of accidents at work place

b. To investigate employee complaints

c. To make representations to the employer about matters of health, safety and

welfare affecting the employees

d. To carry out inspections in the work place to certain provisions

e. To represent the employees in work place consultations with Health and safety

inspectorate

f. To attend meetings of the organizations safety committee.

2.2.9 Safety committees

According to COLE (2000) the regulations relating to safety representatives include

obligations regarding the establishment and operation of safety committee at the work place.

A safety committee is composed of employees and trade union representatives

The overall aim of safety committee is the promotion of co-operation between employers and

employees in investigating, developing and carrying out measures to ensure the health and

safety at work place of employees. The function of safety committee according to COLE

(1997) include:

a. Studying trends in accidents etc with a view to making suggestions for

corrective action

b. examining safety reports and making proposals for avoiding accidents etc

c. examining and discussing reports from safety representatives

d. making proposals for new or revised safety procedures

17

e. Acting as a link between the organization and the enforcement agency (the

Health and safety inspectorate).

f. Monitoring and evaluating the organization's safety policy, and making

proposals for changes if necessary.

BURCHILL (1997) further adds voice to this, and states that a safety committee is

composed of two or more union representatives of employees of the organization. The role of

safety committee thus is to:-

a. Consider welfare, health and safety matters affecting employees.

b. To consider trends in accidents within the firm

c. To consider the causes of specific accidents

d. To undertake a safety training and development and implementation of

safety rules.

According to BURCHILL (1997) there has be to be equal representatives of union members

and management of the committee and the management should have sufficient authority to

implement committee decisions.

2.2.10 Management of health and safety

According to BURCHILL (1997) , a number of regulations on management o f Health and

safety at work came into force in 1993 requiring employees top undertake risk assessment

exercise intended to identify potential dangers to the health and safety of employees or

anyone else likely to be affected by the firms operations.

Health and safety regulations 1992 required the management of the firm to>

a. Devise and implement specific procedures for dealing with emergencies

b. Train employees in safety matters and ensure they are capable of avoiding

risks

c. Take into account working conditions and local work place hazards when

selecting equipment

d. Identify un avoidable risks in relation to handling operations, having regard to

the shape, size and weight of the load and the ergonomic conditions in work

place and humidity available etc

18

According to ARMSTRONG (2000), Health and safety at work place can be managed

through:-

a. Developing Health and safety policies

b. Conducting risk assessment, which identify hazards and assess the risks

attached

c. Carrying out Health and safety audits and inspections

d. Implementing occupational health programmes.

e. Managing stress

f. Measuring Health and safety performance

g. Communicating the need for good health and safety practices

h. Training in good health and safety practices

i. Organizing health and safety

It is evident that Health and safety programs cannot succeed without the involvement and

support of employees. Good employer / employee relationship must be maintained for the

benefits of a healthy and safe work place. The support of trade unions, safety representatives

and committees is always useful for active participation on matters related to Health and

safety at work place and the implementation of Health and safety policies and programs.

2.2.11 External inspections

According to WAWERU (1984), government inspectors visit firms periodically to ensure

they are complying within legal requirements on Health and safety practices. Inspections also

occur following complaints by workers or members of the public and after serious accidents.

If an inspector finds that on offense has been committed, then may either:-

a. Inform the employer on the spot of the unsatisfactory item and later ensure

that remedial action has been taken

b. Serve an important notice compelling positive action

c. Prosecute the firm before a court of law

2.2.12 Accidents and their causes

According to GRAHAM AND BENNET (1998), an accident is an unplanned event which

occur within a planned programme and is actually or potential harmful to the worker.

According to BETTS (1983), accidents are caused by various forms of neglect such as

careless, use of machines or tools, failure to wear protective clothing, taking risks.

19

inconsideration for nearby colleagues, lack of concentration and failure to use safety devices.

All these amount to poor attitude towards safety.

DESSIER (1978), states that there are three factors that contribute to accidents:-

a. Job itself

b. The work schedule

c. The psychological climate

NZUVE (1999) on the other hand argues that the cause o f accidents are first Human and

secondly technical.

Human, when the employees

a. Have improper attitudes

b. Are careless

c. Are unable to perform the job

Technical, when there are deficiencies in plant, equipment, tools or materials and the general

work environment which may constituter poor lighting, exercise noise, poor house keeping

and inadequate ventilation

GRAHAM (1998), further argues that accidents proneness may exist due to:-

i. Unsuitability for the or lack of training

ii. Temporary factors e.g frustrations etc

iii. Alcoholism

iv. Use of drugs

2.2.13 Accidents proneness

According to BETTS (1983), an employee is invariably accident prone, probably because he

has great difficulty in concentrating for any length of time. People who are suffering from

nervous disorder which manifest itself in period of moodiness, temperamental outburst, un

co-operative ness and general antisocial conduct are often faced with certain lapse of

concentration and can cause accidents, hence susceptible to accident proneness.

GRAHAM and BENNET (1998), brings other theoretical approaches to the difference in

accident rates.

a) The domino theory which assess accidents typically occur following practical

series of independent stages involving:-

i. Unsafe environment

ii. Individual's fault

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iii. Dangerous acts

b) The situational; theory which propounds that accidents occur following

failures in working systems rather than behavior or accident proneness.

WAWERU (1984), further argues that all employees do have the same chance to coming by

an industrial accident. He says that accident proneness may have been rendered so by the

psychological make up or work environment itself

a. Insufficient intelligence

b. Poor plant and equipment

c. Physical inadequacies such as poor sight, hearing, smelling etc

d. Ineffective training in safety practices

e. Distance for the job or dislike of the supervisor

f. Insufficient manual skill required to perform the task in the job effectively.

2.2.14 Risk assessment/ health and safety audits

According to ARMSTRONG (2000), risk assessment identify specific hazards and quantity

the risks attached to them, while Health and safety audit provide more comprehensive review

of all aspects o f health and safety policies and procedures and practices for the whole

organization or departments

Risk assessments therefore evaluate and predict risks in qualitative and quantitative terms and

are focused son predicting the probability of effects on health of Human and environmental

resources. It's aimed at:-

a. Hazard elimination through design improvement and change of production

b. Substitution through replacement of chemicals.

c. Use of barriers

d. Use of warning systems like signs, labels, instructions etc

e. Use of personal protective clothing etc

While Health and safety audits cover, the use of:

a. Policies

b. Procedures

c. Safety practices

Safety audits use all the above, but its purpose is to generate action by assessing the practices

and costs and draws up action programs.

21

2.2.15 Safety inspections

According to ARMSTRONG (2000), safety inspection is designed to examine a specific

area of organization like operational or manufacturing production in order to locate and

define any faults in the system. It should be carried out on regular and system basis by the

line managers and supervisors with advice and help of health and safety advisor.

2.2.16 Preventive measures of accidents / accidents report

According to ARMSTRONG (2000), accidents can be prevented by:-

a. Identifying cause or conditions where they are most likely occur

b. Taking into account safety factors at design stage

c. Regular risk assessment and audits

d. Investigating all record

e. Maintaining good record

f. Good leadership and motivation

g. Designing safety equipment, protective devices and protective clothing

h. Continuous training and education of staff

Dessler (1978), argues that in order to prevent accidents, the following have to be

undertaken:-

a. Reduction is unsafe conditions

b. Proper selection of employers

c. Use of propaganda like posters

d. Training

e. Positive re-enforcement

GRAHAM AND BENNET (1978), brings in the concept o f ergonomics, which is concerned

with the study o f mutual adjustment between people and their work. This is possible through

designing equipment, the environment and work and working procedures which promotes

both well - being of employees and effectiveness of work processes. Environment here

include Heating, ventilation. Sayles (1981), accidents can be prevented through:-

a. Engineering i.e. construction of safe plant tree from potential hazards

redesigning machinery equipment and equipment etc

b. Selection approach, where accident-prone workers should not be hired

c. Establishment of safety department to make policies and regulations and

programs

d. Staff where by safety department is established to and safety supervisors

22

WAWERU (1984), says that supervisor, should ensure a safe working environment by

training employees on safety practices

According to the GRAHAM (1998), accident reports are useful in identifying and preventing

the occurrence of dangerous activities, by analysis recurring case and effects to dangers in

machinery, work methods, paces of production, shift work pattern etc on the frequency of

accidents.

2.2.17 Compensation for accidents at work

According to GRAHAM AND BENNET (1998), an injured employee who considers his/her

injury to be due to the negligence of the employer may bring an action for damages under the

common law. The employer is held liable for accident caused was in the course of their

employment.

If action is successful the employee is awarded a sum depending on the severity o f the injury.

The employer’s liability act (1969) requires employers to take out insurance against such

claims. Such claims are independent o f any action.

2.2.18 Legal requirement regarding health and safety.

NZUVE (1999) and DESSLF.R (1978), both agree that organizations have both moral and

legal obligation to provide a healthy and safe working environment as well as ensuring the

total well being of their employees. In addition, Dessler adds the economic factor, which has

led employees to provide health and safety programmes to reduce cost incurred in paying out

compensation and repair of damaged equipment. Consequently there is developed legislation

allover the world that required employees to abide by safety regulation in Kenya, the

factories act cap 514 of the laws of Kenya and amended in 1990 to protect the workers from

accidents and secure for them, in employment, conditions conducive to their health and

safety. The provision of this act require employers to maintain an inspection staff and make

provision for maintenance of Health, cleanliness, prevention of overcrowding, and amenities

like lighting, ventilation, drinking water and sanitary conveniences.

The general provision of the act includes the development of safety programs, which on

compass:-

a. A thorough investigation of all accidents and a system of and procedure for

reporting accidents illness, safety and Health hazards, fire precautions and

arrangements for maintaining high standards of hygiene with regard to

harmful substances.

23

b. Arrangement for sufficient information, instructing work people on safe

working methods and training employees in Health and safety matters.

c. Continuous review of accident prevention measures and ensuring that

machines are guarded, gangways kept clear, electrical equipment insulated and

house keeping requirements maintained

d. Special rules for work done at a height in confined spaces and on certain

unguarded machinery.

e. Maintenance o f equipment and provision o f proper inspection and testing

arrangements

f. General rules on safe working habits and special rules for internal transport

drives

g. Arrangement for checking new machinery

h. Safe inspections

i. Safety devices and the provision of personal protective equipment and rules as

to its use.

j. Provision of any accidents which occur.

The workman’s compensation act cap 136 of the laws of Kenya was passed in 1948 in order

to provide for the payment of compensation by certain classer of employers to their workmen

for:-

a. Personal injury caused to them by accident

b. Any occupational disease contracted by them.

Sect 5(1) of the act states that “ if in any employment, personal injury by accident arising out

of and in the course of the employment is caused to a workman, his employer should subject

as there after provided, be liable to pay compensation in accordance with the provision of

this, and as for the purpose of this act an accident resulting in the death or serious and

permanent incapacity of a workman, shall be deemed to arise out of and in the course of his

employment.

Injury in this case is only physical and mental, but also psychological and physiological. This

act lays down rules for compensating deaths, permanent total incapacity, permanent partial

incapacity, temporary incapacity and method of calculating earnings.

The employment act cap 226 of the laws of Kenya was also passed and among its

provisions, states:-

a. There must be at least one rest day every week for each worker

24

b. The employer shall provide some reasonable medical facilities to the

employees

c. The employer shall supply sufficient supply o f water

In Britain according to GRAHAM (1998) and PART (1979), the Health and safety at work

act 1974 was passed. The act lays down general principles o f safety and providing the power

to make detailed safety regulations.

The principle duty of the employer according to the act as stated by COLE (2000) is

a. To ensure, so for as is reasonably practicable the health, safety and welfare at

work of all employees. More specifically, the employer is expected:-

b. To provide and maintain plant and systems o f work that are safe and without

risks.

c. Ensure safety in the use, handling, storage and transport of articles and

substances

d. To provide sufficient information, instruction and training and supervision to

ensure Health and safety of all employees.

e. To maintain a safe place of work and safe means of access and exit.

In India, according to GUPTA (1996), the factories act was passed in 1948 and it has

provision on:-

a. Cleanliness

b. Disposal of waste and effluents

c. Ventilation and temperature

d. Dust and fumes

e. Over crowding

f. Latrines and urinals

In America, the occupational safety and health act (OSHA) was passed in 1970. SAYLES

(1981) stated and healthy work environment and to live up to the explicit standards.

Consequently the occupational safety and health act formulated standards which employers

work expected to meet. The declared congressional purpose and policy of the act as quoted

by CASCIO (1981), was to assure so far as possible, every working man and woman in the

nation safe and healthful working conditions and to preserve Human resources.

This was followed by creation of:-

i. The occupational safety and health administration

ii. The national Advisory committee on occupational health and safety

iii. The occupational review commission.

25

IV. The national institute for occupational safety and health.

According to BURCHILL (1996) and BENNET (1997) under the health and safety work

act (1974), firms have a general duty to ensure so far as to reasonably practical, the health

and safety at working for all employees. Breach of this duty can lead to a criminal

prosecution. Plant, machinery and other equipments must be safe and well maintained and all

arrangements for handing, storing and transporting articles and substances must be safe and

free of health hazards.

The act acquires employees to take reasonable care to ensure they neither endanger

themselves nor others at work, but it is the responsibility o f the employer to insist that safety

policies are implemented. Health and safety executive’s issues codes of practices which while

not legally binding are looked by courts when adjudicating cases.

BETTS (1993), says in addition to solid obligations of health and safety, there are two main

sources of law which protect the employee:-

i. The common Law (written), established by customs and is supported by

precedents which are referred to as case law

ii. Statute law - passed by parliament in 1974 its broad and generalized in nature,

under the common law there is a liability for safety of employees. The

employer may be sued for danger if he does not provide reasonably safe

systems of work. If the employer ignores this obligation, the injured person

may sue for damages and in serious cases the state may consider the offence a

crime and prosecute. Another legal aspect o f safety measure arises when an

employee commits a civil wrong, or tort during the course of his employment,

he is liable to civil suit.

Statute law aims at:-

a. To secure Health, safety and welfare o f people at work by involving every body

at work

b. To protect people other than those at work against any risks to Health and safety

arising out of or in connection with the activities of people at work

c. To control storage and use of explosives or highly inflammable or dangerous

substances

d. Control the emission into the atmosphere of toxic or offensive substance from

prescribed premises

26

NB: It has become increasingly recognized that an employee Health and Safety have some

bearing on productivity, and that governments through appropriate legislations have put

pressure on employer to ensure safety and good Health of workers.

In the developed economics employers have on the whole accepted the idea of minimizing

industrial injuries and accidents and have instituted their relevant programmes on positive

measures to promote the physical and mental health and welfare of workers.

In the developing economics, however, the employers have not been particularly bothered

about the well-being of the workers and the government invention has been invariably been

necessary.

In Kenya, the Health and safety situation in the Locally incorporated and smaller companies

has been on the whole less satisfactory than that of the subsidiaries of the internationally

firms, hence workers safety and general health programs left much to be desired as per the

standards set by the factories act cap 514.

From the employee's point o f view, industrial injuries and poor health could occasion

considerable loss in the long run and in the short term. The situation is more worse with the

worker who may incase of major injury is not covered by insurance policy, hence through the

relevant legislations as enshrined in their provisions, it important for employers to reduce the

rate of injuries and infringement on workers Health as earlier stated.

2.2.19 Health and safety education and training

According to ARMSTRONG (2000), safety training spells out the rules and provides

information on potential hazards and how to avoid them.

It is part of the preventive program. This is done through:-

a. Induction course

b. Transfer to new job or changes in working methods

c. Refresher course and training should be provided to deal with aspects of Health

and safety to employees.

BETTS (1983), further argues that lack of experience and poor training also cause accidents.

The question o f safety and the correct method of performing a task are an essential part of

any raining scheme. The importance of correcting bad habits as they appear is emphasized

from the safety aspect and the supervisor must check new and existing employees for

allowing a new comer to work on his own before reaching a suitable level of competence is

inviting him to have an accident.

27

According to BENNET (1997) and BURCHILL (1996), section 2 of the Health and safety

act (1974) requires employment to provide training and instructions to workers. In this are

two types of training:-

a. Training in rules and regulations

b. Policy training for managers

Safety training needs to cover the law codes of practice relevant to the organization.

According to V.N. BHAT (1998), health and safety training includes training on personal

protective equipment, emergency preparedness and documentation pf accident courses.

28

2.3 Conceptual framework

Independent

variables

MODERATING VARIABLE

29

In the above conceptual framework, health and safety practices (Dependent variable) is

influenced by a number of factors which form the independent variables and include the

legislation, the employees concerns, the managers attitude , safety committees, accidents,

management of health and safety programs and health, safety education, training and

awareness. However, the independent variables are also influenced by the moderating

variables which affect the direction and or strength of the relationship between the two

relationships (Dependent and independent variables). These moderating factors include, the

organizations approved budget towards the health and safety provisions, Public concerns,

external inspectors and law enforcing agent / government.

The legislation comprises of the health and safety at work act (1974).This act gives legal

expected standards in health and safety matters which are mandatory for all.

Employees are also important in determining the safety and health practice. They ought to be

aware what constitutes safe working practices as they affect them and their fellow workers.

Managers also exert greater influence on health and safety. They are directly responsible for

ensuring the employees are conscious o f health and safety hazards and do not take risk. They

are also in immediate control and it’s up for them to keep a watch for unsafe conditions or

practices and to take immediate action.

Safety committees also influence the safety practices at the hospital in that they advice on

health and safety policies and procedures , help in conducting risk assessments and safety

audits and make suggestions on improving health and safety performance.

Finally the management, whose role is to develop and implement health and safety policies

and ensures that the procedures for carrying out risk assessments, safety audits and

inspections, are implemented. Management, besides, has a duty of monitoring and evaluating

health and safety performance and taking corrective action as necessary.

The above mentioned factors are however affected by the available budget which constrains

what is desired safety and healthy practice and what is actually provided.

Similarly, the law enforcing agents may be compromised not to ensure the provisions of the

legislation are not followed to the letter. The public may also regulate the health and safety

practice by putting pressure on the hospital management to provide good health and safety

practices.

30

2.4 Summary of literature

From the forgoing literature review, it is evident that an effective health and safety policy and

program are vital and a legal requirement for any organization with more than five

employees.

A written safety and health program guides the management in handling health and safety

matters in an organization. Failure to implement the policies leads to accidents, which are

costly both to the employers and employees. Management commitment and integration of

safety and health concerns in planning in same footing with other core functions like

productivity and quality is vital in any organization. Employers should be involved and

trained in health and safety practices. Programs need to be reviewed constantly since methods

of production keep changing and are always accompanied by new risks and hazards.

Both management and employees have a collective responsibility to improve health and

safety in the organization. The burden of the legal responsibility however rests with the

management. The legislation gives employees through their representatives a say in health

and safety matters. These representatives are however not liable to legal responsibility.

It is important for the management to meet the standards set by the health and safety

legislations. It is cost effective to avoid industrial accidents than compensation.

Procedures for identifying and eliminating dangerous situations should be in place and

adequate information, on how to use tools, equipment and plant safely should be

disseminated to employees. Protective equipment and clothing should be a priority to prevent

workers from unsafe situations and environments. The health and safety policy should

describe the duty of every one in the organization. Training programs, seminars and

workshops should be encouraged for employees or their representatives for a health and

safety work environment and practices

The study, therefore intends to suggest possible solutions to the health and safety practices at

the main private hospitals in Mombasa, and it is hoped same will assist the administration of

the Hospital to minimize and protect employees from unsafe working conditions and

practices.

31

CHAPTER THREE RESEARCH METHODOLOGY

3.1 Introduction

This chapter describes in details the research process, research design, target population,

sample size, data collection method and data analysis methods.

3.2 Research design

The research utilized descriptive study with a mix approach of qualitative and quantitative

design. The data was collected through a series of formal interviews and participatory

observations. This provided a descriptive form of the opinions of the staff of various hospitals

regarding occupational health and safety practices in their hospitals.

3.3 Target population

The study was done at the private hospitals in Mombasa Island whose bed capacity is eighty

and above: Mombasa hospital, Pandya memorial hospital and Aga Khan Hospital whose staff

establishment is 180, 210 and 240 as shown in table 3.1. However the study utilized a sample

due to limited time, cost and labour resources. Some of the staffs also works in shifts and in

different hours which made it difficult to reach them. The distribution of staff per cadre is as

shown in the table 3.2 below.

Table 3.1: Target Population

HOSPITAL NUMBER OF

BEDS

NUMBER OF STAFF

PANDYA 95 180

MOMBASA 80 210

AGA KHAN 111 240

TOTAL 286 630

32

Table 3.2 Distribution o f staff per cadre

No. Cadre PANDYA MOMBASA AGA KHAN TOTAL

POPULATION

1 Doctors 9 11 12 32

2 Administrative

Officers

4 4 4 12

3 Clerical Officers 4 4 4 12

4 Drivers 2 3 2 7

5 Clinical Officers 18 21 24 63

6 Copy Typists 9 11 12 32

7 Support staff 54 63 72 189

8 Nurses 36 42 48 126

9 Lab Technicians 7 8 10 25

10 Pharmacists 9 11 12 32

11 Radiographers 5 6 8 19

12 Oral Health

Technician

7 8 10 25

13 Occupational

therapists

7 8 10 25

14 Medical Records

Officers

4 4 4 12

15 Physiotherapists 5 6 8 19

TOTAL 180 210 240 630

3.4 Sample size and sampling procedures

Out o f the 10 employees a sample of 5 employees was selected for study through stratified

random sampling technique. This represents 50% of the total work force in three private

hospitals in Mombasa Island that are available to fill safety and health practices

questionnaires. The sampling frame is as shown in table 3.4.

33

The respondents who will fill up the questionnaires will be selected using proportionate

stratified sampling to ensure representation o f all cadres, job groups, gender and nature of

work. Stratification will ensure that the sample represents staff in proportion in which they

exist in actual population. The study will involve all the departmental heads and other staff

from all the three private hospitals in Mombasa.

The researcher will use stratified sampling frame which fits, because the population is

heterogeneous and not of the same characteristics as analyzed in the overall population

Both random and systematic sampling techniques assume that the population is evenly

distributed or randomly distributed. This is not usually true in real life where populations are

quite often unevenly distributed. In such cases both random and systematic samplings tend to

generate a sample which over represents dispersion and under represents concentrations.

Stratified sampling therefore, attempts to overcome this problem of over or under

representation. The researcher therefore will use stratified sampling by dividing the

population into sub-groups or strata (stratum), which will be done according to the degree of

concentration o f occurrence. Samples will then be drawn from each stratum to ensure that

each stratum is adequately represented. The size of the sample to be drawn from a stratum is

controlled by the proportion o f that stratum in the population.

Once stratification is done on the basis o f concentration and dispersion, random or systematic

sampling will be used to obtain the sample and give each respondent a non- zero probability

of being selected. This method is convenient as it will produce more spread o f the sample

over the population list. This will lead to greater precision. The sample fraction will be used

to obtain random individual unit from the sampling frame, hence the respondents selected

will be a representative of the larger population since element of one stratum will have the

same characteristics.

The researcher will select 321 employees from the whole population of 630 i.e. a percentage

of 50.95%. It is expected that out o f the selected population a certain percentage will not

respond.

34

Table 3.3 Sampling Frame

No. Cadre PANDYA MSA

HOSP

AGA

KHAN

TOTAL

1 Doctors 5 5 6 16

2 Administrative Officers 2 2 2 6

3 Clerical Officers 2 2 2 6

4 Drivers 1 2 1 4

5 Clinical Officers 9 11 12 32

6 Copy Typists 5 6 6 17

7 Support staff 27 32 36 95

8 Nurses 18 21 24 63

9 Lab Technicians 4 4 5 13

10 Pharmacists 5 6 6 17

11 Radiographers 3 3 4 10

12 Oral Health Technician 4 4 5 13

13 Occupational therapists 4 4 5

14 Medical Records

Officers

2 2

W i

2 -(5 2.

2c:w-.? -

‘nn T u rn

1; AJISi:15 Physiotherapists 3 3 4 10

TOTAL 94 107 120 321

3.5 Data collection methods

The data collected started with a meeting with management o f each of the three hospitals to

discuss the exercise and agree. This was then followed by meeting with the employees to

administer the research instrument and conduct the survey. The procedure to collect data was

influenced by the research instrument used.

35

Primary data collection - This was the main source which involved the use of questionnaire

and key interview guides. In view of the above mentioned approach the following

instruments was developed for use by the researcher.

a) Key interview guide- for heads of departments and representatives groups

b) Questionnaire - All other staff: Clerks, Copy typists, Cleaners etc.

c) Observation -

Interviews

The researcher w ill developed a list o f relevant questions on items to be administered to the

heads of department and request them to answer some questions. The researcher and assistant

noted the answers given, the data obtained was in exact accordance with instructions.

Questionnaires

This was administered directly to informants. The respondents filled in answers in written

form and the researcher collected the form with completed information. The instruments

were distributed to the respondents by the researcher and researcher assistant. Respondents

were then be given time to complete answering questionnaires. All questionnaires were

gathered after a given response time is over. The questionnaire consisted of both closed

ended questions and open ended options.

Observation

The researcher prepared an observation schedule giving guidance to activities to be recorded

in during observation study.

Secondary data collection - This was collected and critically examined from published and

unpublished materials, textbooks, journals, official record in search of information on past

and current operation of the three hospitals.

3.6 Data collection procedure

The data was collected by the researcher himself through the various instruments

a) Observation

The researcher observed the prohibited and precautionary measures in place, procedures in

place, working environment, conditions of plant tools and equipment, working environment

in the kitchen, wards, laundry' and various departments as well as the welfare facilities in

36

place. The observation will be noted and recorded in the observation guide. The researcher

%vill also o b se rv e the employees at work especially the nurses who are having poor

perform ance. T h e researcher will read their report, look at the chart and watch them do some

nursing procedu res such as giving medication.

b) In terview guide

This method comprised mainly of both structured and un-structured type o f questions.

Interview w a s conducted with administrators and departmental health and recorded in the

notebook.

c) Q uestionnaire

Questionnaire w as administered to the respondents and collected after an agreed time after

they are d u ly completed. The respondents filled the questionnaires themselves. The

respondents included nurses, doctors both trained and untrained staffs, kitchen staff and

maintenance c rew .

d) D ocu m en t analysis

The researcher perused documents and other reports related to the study and record the

information in a notebook.

3.7 Validity' an d reliability of research instruments

Before co llec tin g data the researcher pre-tested the research instrument. A pilot study was

conducted u s in g a randomly selected sample of 10 staff in each hospital. This helped to find

out if 'e v e ry th in g works’ as far as the research instrument is concerned. This will assist in

foreseeing a l l potential misunderstanding or biasing effects of different questions and

Procedures. It will also help in testing the viability of the study techniques and to perfect the

Questionnaire concept and wording. The findings from the study will be used to measure the

Pliability o f d a ta collection instruments.

3.8 Ethical consideration

1 he researcher ensured the following ethical issues are observed;

(a) T he researcher maintained confidentiality

37

place. The observation will be noted and recorded in the observation guide. The researcher

will also observe the employees at work especially the nurses who are having poor

performance. The researcher will read their report. look at the chart and watch them do some

nursing procedures such as giving medication.

b) Interview guide

This method comprised mainly of both structured and un-structured type o f questions.

Interview was conducted with administrators and departmental health and recorded in the

notebook.

c) Questionnaire

Questionnaire was administered to the respondents and collected after an agreed time after

they are duly completed. The respondents filled the questionnaires themselves. The

respondents included nurses, doctors both trained and untrained staffs, kitchen staff and

maintenance crew.

d) Document analysis

The researcher perused documents and other reports related to the study and record the

information in a notebook.

3.7 Validity and reliability of research instruments

Before collecting data the researcher pre-tested the research instrument. A pilot study was

conducted using a randomly selected sample of 10 staff in each hospital. This helped to find

out if ‘everything works' as far as the research instrument is concerned. This will assist in

foreseeing all potential misunderstanding or biasing effects of different questions and

procedures. It will also help in testing the viability of the study techniques and to perfect the

questionnaire concept and wording. The findings from the study will be used to measure the

reliability of data collection instruments.

3.8 Ethical consideration

The researcher ensured the following ethical issues are observed:

(a) The researcher maintained confidentiality

37

(b) The researcher obtained informed concept from any subjects used in the study and

must ensure that all subject participate voluntarily.

(c) The researcher fully explained the research in advance and debrief subjects

afterwards.

(d) The researcher took all reasonable measures to protect subjects physically and

physiologically. Even voluntary participants can get “carried away” to the point were

they have to be protected from themselves and each other. The researcher must be

prepared to intervene even at the cost of the study to protect the subject.

3.9 Data presentation and analysis techniques

After collecting data, the researcher pre-prosed it (edited it) this involved collecting problems

that are identified in the raw data like different results obtained by the two researcher

assistant. This involved eliminating unusable data especially were the researcher finds two or

more questions providing the same data. It also involves interpreting o f ambiguous answers

and verify or reject contradictory data from related questions.

A coding scheme is then formulated after editing the raw data by correcting any error that

may influence data analysis. This involves assigning numbers or other symbols to answers or

responses so that the responses can be grouped into a limited number o f classes or categories.

After coding the data is entered into a computer and then stored electronically. A statistical

software package is chosen which is relevant to the data analysis. In this case the data was

stored under SSP (Statistical simplest package). The data is then analyzed and displayed

using tables, chart/graphs and percentages.

38

3.10 Operational definition of variables

The table below explains how the researcher will go about measuring the inferences he has

indicated in the study.

Objective DependentVariable

Independentvariable

Indicators Instrumentused

Scale

To establish the extent to which Kenya labour laws, workman’s compensation act and health and safety at work act, influence safety and health practices at the main private hospitals in Mombasa Island.

Health and safety practice in the main private hospitals

Safetycontrolmeasures

i. Warning signs and personal protective equipmentsii. No o f staff wearing protective clothing

Observation Nominal

To establish the extent to which management of health safety programmes influence Health and Safety Practices at the main private hospitals in Mombasa Island.

Health and safety practice in the main private hospitals

Health andsafetypolicies

Safety Personnel i. Interviewii. Questionnair e

Nominal

To establish the extent to which safety committees influence health and safety practices at the main private hospitals in Mombasa Island.

Health and safety practice in the main private hospitals

Safetycontrolmeasures

i. Existence of safety committeesii. Health and safety awareness meetings

Interviewquestionnaire

Nominal

To establish the extent to which health and safety education or awareness influence health and safety practices at the main private hospitals in Mombasa Island.

Health and safety practice in the main private hospitals

Training Safety conscious number of training on record

QuestionnaireInterviewObservation

Nominal

To establish the extent to w hich accidents influence health and safety practices at the main private hospitals in Mombasa Island.

Health and safety practice in the main private hospitals

Accidentsrecords

Incidents and injuries

QuestionnaireInterviewObservation

Nominal

39

CHAPTER FOUR

DATA ANALYSIS, PRESENTATION AND INTERPRETATION4.1 Introduction

This chapter describes the data presentation and findings. The data was collected using

questionnaires, observation guide, interview guide and from staff records.

Data analysis started as soon as the first questionnaires were received. The researcher set-out

to establish the current health and safety practices in place, to identify the factors affecting

the effectiveness o f the Occupational Health and Safety practices in The private Hospitals in

Mombasa Island and to come up with some recommendations towards improvement of the

situation.

The researcher analyzed the collected data with the help o f tables, pie charts and bar graphs.

The analysis covers the following sub-topics. The distribution o f employees at The private

Hospitals in the Island, the level o f education o f staff, health and Safety programmes in place,

health and safetv education and training, legal requirements like protective equipment,

Working environment and Management commitment and how the influence the occupational

health and Safety practices in the private hospitals in M ombasa Island.

4.2 Distribution o f employees at the private hospitals

The researcher sought to know the distribution o f employees in the private hospitals at

Mombasa Island. He further grouped the staff into five cadres which included the medicals,

paramedics, subordinate, technical and non technical the information which was obtained

from the questionnaires was tabulated as shown below.

40

\CadrCadre Medics ParaMedics

Technical Staff SubordinateStaff

NonTechnicalStaff

Total

Pand>a Hospital 18 54 10 21 77 180

Mombasa

Hospital

22 63 12 24 89 210

Aga Khan

Hospital

24 72 16 30 98 240

Total 64 189 38 75 264 630

Table No. 4.2 Show ing distribution of employees

From the table and pie chart above, it shows that 30% o f the staff in the private Hospitals are

paramedics (clinical officer nurses), 12% subordinate staff, 6% technical staff (lab

technicians, occupational therapist), 42% non-technical staff (drivers, adm inistrate officers,

copyist), while 10% are the medics (Doctors and the pharmacists)

43 Number o f respondents from the questionnaire distributed.

From the research a certain number o f questionnaires issued to the sampled

population w ere not returned. This information was tabulated and analyzed as shown

below.

Cadre o f staff Total number o f

s ta ff number o f

s ta ff in the

hospitals

Total number o f

questionnaire

issued

Total number

o f

questionnaires

received back

Percentage of

response from the

sample total

P A M P A M P A M

Medics 36 48 42 18 24 21 11 15 13 39/63=62%

Paramedics 54 72 63 27 36 31 16 22 19 57/94=60%

Technical 27 36 32 14 18 16 8 11 10 29/48=60%

|Non-Jgchnical

18 24 21 9 12 11 6 7 7 20/32=63%

Subordinate 45 60 52 23 30 26 14 18 16 49/79=61%

Total 180 240 210 91 120 105 55 73 65

Table No. 4.3: Dem ographic characteristics o f respondents

41

SB P represents Pandya Hospital, A - Aga khan Hospital and M - Mombasa Hospital

The above table illustrates that out o f the sampled population o f employees who were issued

with questionnaire only 193 responded by returning them, a percentage o f 61%. This was a

good representation and the researcher was able to get information to enhance him get data,

make viable recommendations based on findings.

4.4 LEVEL OF EDUCATION OF RESPONDENTS

The researcher sought to establish if health, safety education, training and awareness

influence the health and safety practice in the hospitals. He gathered information on the level

of education o f the respondents and also the levels o f health, safety education, training and

awareness. The data collected was as analyzed below.

LEVEL OF EDUCATION NUMBER OF RESPONDENTS PER

HOSPITAL

TOTALS PERCENTAGE

P A M P + A + M

University 13 16 15 44 23

Secondary 19 26 23 68 35

Diploma 14 19 17 50 26

Certificate 9 12 10 31 16

TOTAL 55 73 65 193 100

Table No. 4.4: level o f education of the staff

From the sampled population o f 316 employees only 193 responded in filling the

questionnaire and were able to be interviewed by the researcher o f which their response is

displayed in table No. 2

The overall rating on the levels of education is that out o f the 193 respondents 44 have

acquired a university degree a percentage o f 23%. Those that have attained secondary

education (O-levels) a percentage of 35%. 50 have acquired a diploma in respective

profession a percentage o f 26%. The other 16% i.e. 31 respondents acquired a certificate.

Therefore the findings, indicates that the respondents were able to read and understand the

Occupational Health and Safety rules and regulations.

42

4i HEALTH AND SAFETY EDUCATION AND TRAINING

The respondents were required to explain in the questionnaire whether they have undergone

joy Health and Safety training. They responded as shown in table No. 5 below.

OPINION FREQUENCIES TOTAL PERCENTAGEPANDYA AGA

KHANMOMBASA

HOSPITALHave attended training 21 28 25 73 38Have not attended

training

34 45 40 120 62

TOTAL 55 73 65 193 100

Table No. 4.5: attendance of Education and training on Health and safety matters.

The overall rating on health and safety education is that 62% of the staff who responded did

not undergo any training course, seminar or workshop on health and safety and that such

matters are not emphasized during staff meetings. Most o f the employees hence have little

knowledge of the Health and Safety guideline. This information is also displayed in the bar

graph No. 1 in the next page.

The bar chart shows that 120 respondents out of 193 have not undergone any training, and

have no education or information on Health and Safety while only 73 staff members have

undergone such training especially on the job training and seminars as it was evident from

their response in the questionnaires.

4.6 MANAGEMENT OF HEALTH AND SAFETY PROGRAMS IN THE

PRIVATE HOSPITALS AT MOMBASA ISLAND.

Management of health and safety programs in the hospitals has an influence on the

Occupational health and safety practices in the hospitals. The researcher tried to find out

whether there is existence of health and safety programs in place at the hospi

43

The response is as tabulated below.

OPINION FREQUENCIES TOTAL PERCENTAGE

PANDYA AGA

KHAN

MOMBASA

HOSPITAL

Exist 11 15 15 41 21

Do not exist 45 57 50 152 79

TOTAL 56 72 65 193 100

Table No. 4.6: existence of health and Safety programme

The above table indicate that, only 41 respondent out o f 193 conceded that there is a health

and safety programme in existence to guide the management on the course o f action to

maintain a safe and healthy working environment for its staff. 152 respondents composing o f

79% of the total respondents indicated that there is no Health and Safety priogramme in place

and do not know the standard of behavior expected o f them in health and safety matters. The

respondents attributed this due to lack o f management commitment, lack o f funds, materials

and proper instruments to ensure the success o f the programme. This is also aggravated by

lack o f education and training and inadequate facilities.

The researcher however, from the observation guide noted that no regular inspection on

Hospital facilities was carried out. No records o f accidents or incidents. Were kept Research

on accidents is not kept as well.

4.7 Legal Requirements Regarding To Health And Safety

The researcher sought to find out whether the hospitals comply with legal requirements by for

example giving out warning signs for safety and also provide safety equipments like hand

gloves, protective clothing, overalls and others.

The observation was done on presence o f writings and displayed instructions and warning

signs on health and safety and was captured as shown below.

Opinion Frequencies Total Percentage

Pandya Aga

Khan

Mombasa

Hospital

Yes 22 29 26 77 40

No 33 44 39 116 60

t o t a l 55 73 65 193 100

Table No. 4.7: the presence of safety instructions and w arnings.

44

From the table above, it is evident that the Hospital do not displayed posters and warning on

safet> matters as required by the Law. The overall rating on presence o f writing and

displayed instructions and warning signs o f health and safety is 60% of the respondents said

there are no such warning signs in place while 40% stated that there was presence o f written

and displayed instructions on safety.

I The researcher, as well through the assistance o f the observation guide was able to establish

I that the posters were only on isolated places and some were not legible enough to convey the

I message. This was an indication that safety matters and regulations were not given enough

emphasis by the management of these private Hospitals.

4.8 Working Environment and Ergonomics

The researcher sought to find out the working environment and its influence on health and

safety practices in the hospitals. This w as done with the aid o f observation guide. The

researcher visited the following Hospital facilities which included Hospital laboratories, X-

ray departments, Pharmacies, Hospital kitchens, Laundries, Various wards, Theatres. He also

observed the presence and use o f protective equipments which included, hand gloves,

Overalls, Safety foot wear (gum bools), Caps used in theatre. Face masks, Breath bag

apparatus, and Safety helmets.

The general cleanliness was fairy adequate with exception o f a few wards som e were on

renovation. The ergonomics was good the respondents were asked whether the environment

affects them. Observation was done on the working environment and the analysis was shown

below.

The respondents were asked to state on the questionnaires, w hether the protective equipment,

devices and protective clothing provided w ere adequate. The analysis is as below:-

OPINION FREQUENCIES TOTAL PERCENTAGE

PANDYA AGA

KHAN

MOMBASA

HOSPITAL

Not 23 35 35 100 52

affected 93 48

Affected 20 50 30

total 43 85 65 193 100

f able No. 4.8: Environm ent and ergonom ics affecting the sta ff

45

The overall rating from the findings was that 52% o f the respondents stated that there were

adequate protective equipment in the place o f work, while 48% said that the protective

I equipment provided to them were not adequate. From the results it’s evident that the

I equipment and clothing were not adequate and were required to be procured to satisfy the

requirements.

The researcher observed that due to shortage o f the protective devices, some o f the staff

I attends to patients w ithout the use o f the devices to protect him self from injury or disease.

* The equipments are inadequate. Some respondents though provided with the protective

devices do not use them , due to lack o f training, negligence and poor supervision.

4.9 MANAGEMENT COMMITMENT TOWARDS HEALTH AND SAFETYIt is the duty o f management o f any firm to device and implement specific procedures and

documents to minimize accidents, to train members in health and safety matters. They must

also issue a written statement o f safety policy as well as maintaining an arrangement which

provide and develop measures for safety and health o f employees whilst checking on the

effectiveness o f such measures.

From the research findings 56% of the respondent strongly refuted the management

commitment o f health and safety m atters on the hospital and 44% agreed that the

management is committed.

4.10 TESTING OF HYPOTHESISIn order to find the relationship between the hospitals’ workers knowledge on health

and safety and the different hospitals, the following Hypotheses were tested.

4.10.1: Hypothesis 1

Ho: Hospital workers knowledge o f occupational health and safety does not differ

significantly am ong hospitals.

Hi: Hospital w orkers knowledge o f occupational health and safety differ significantly

among hospitals.

Using the data obtained about the level o f education, knowledge and safety o f the staff

the following table was used.

46

Level Of Education Actual Frequencies Totals Percentage •

Pandya Aga Khan Mombasa P + A + M

[University 13 16 15 44 23

Secondary 19 26 23 68 35

Diploma 14 19 17 50 26

Certificate 9 12 10 31 16

TOTAL 55 73 65 193 100

4.10.1.0: level of education and knowledge of occupational health and safety o f the staff

The above table shows the level of education and awareness of occupational health and

safety practices.

The information is arranged in a 3 x 4 table as follows.

Level Of Education Actual Frequencies Totals

Pandya Aga Khan Mombasa P + A + M

University 13 16 15 44

Secondary 19 26 23 68

Diploma 14 19 17 50

Certificate 9 12 10 31

TOTAL 55 73 65 193

4.10.1.1: Frequencies of levels o f education and knowledge of occupational health andsafety of the staff.

47

On the basis o f those frequencies, the expected frequencies were calculated as below:-

Level of Education Expected Frequencies Totals

PANDYA AGA KHAN MOMBASA P + A + M

Universityi 44/193x55=13 44/193x73=16 44/193x65=15 44

Secondary 68/193x55=19 68/193x73=26 63/193x65=23 68

Diploma 50/193x55=14 50/193x73=19 50/193x65=17 50

Certificate 31/193x55=9 31/193x73=12 51/193x55=10 31

TOTAL 55 73 65 193

4.10.1.2: Expected frequencies of levels of education and knowledge o f occupational health and safety of the staff.

The x2 calculated is as follows;

O E (O -E ) (O -E )2 ( O - E I 2

E

13 13 0 0 0

19 55 -36 1296 23.564

14 14 0 0 0

9 9 0 0 0

! 16 16 0 0 0

26 26 3 9 0

19 19 0 0 0

12 12 0 0 0

15 15 0 0 0

23 23 0 0 0

17 17 0 o 0

10 10 0 0 0

TOTAL 23.564

4.10.13: Chi Calculated on hypothesis 1

Chi Square = Sum (0 - E) = 23.564

E

V=Number o f degrees of freedom =(r - 1) (c - 1) = 1x2 = 2 degrees of freedom

For two degrees of freedom at 5% significant the critical value for Chi Square = 5.991.

48

0 E (O -E ) ( O - E ) 2 (O - E ) 2

E

I 'll 12 -1 1 0.083

15 15 0 0 0

15 14 1 1 0.071

45 44 1 1 0.023

57 57 0 0 0

50 51 -1 1 0.020

TOTAL 0.197

Table No. 4.10.2.2: Chi calculated 2

Chi Square = Sum (0 - E) 2= 0 197

E

Number of degrees of freedom =(r- 1) (c - 1) = 2x1 = 2

For two degrees of freedom at 5% significant the critical value for Chi Square = 5 991

The calculate value for x2 (0.197) is less than the critical value and hence our null hypothesis

may be accepted at 5% level of significant. We therefore conclude there is no significant

difference in the attitude of existence of health and safety- programs in the private hospitals

Mombasa Island

4.10J: Hypothesis testing 3

The 3rd hypothesis tested was on working environment and Ergonomics.

Ho: there is no relationship between the opinion about the environment in the different

private hospitals in Mombasa Island

Hi: there is relationship between the opinion about the environment in the different private

hospitals in Mombasa Island

V\

50

The data obtained from the questionnaire on the above subject was tabulated below:-

OPINION ACTUAL FREQUENCIES TOTAL PERCENTAGE

Pandva Agakhan

Mombasa

Not affected 20 50 30 100 52

Affected 23 35 35 9348

TOTAL 43 85 65 193 100

4.103.0: Opinion from staff about the environment and ergonomics and whether it

affects them.

The information is arranged in 3x2 table as follows;

Attitude Those who believe it

affects

Those who do not

believe it affects

them

Total

Pandva 20 35 55

Aga Khan 50 23 73

Mombasa 30 35 65

Total 100 93 193

4.103.1: Frequency of opinion on attitude a

On the basis o f that the expected frequencies ai

lout the environment and ergonomics

•e as follows:

Attitude Those who believe it

affects

Those who do not

believe it affects

them

Total

Pandva 55/193 x 100= 28 55/193x95=27 55

Aga Khan 73/193x100=38 73/193x93=35 73

Mombasa 65/193x100=34 65/193x93=31 65

Total 100 93 193

4.103.2: Expected frequency of opinion on attitude about the environment and

ergonomics

Therefore the following table was derived.:

51

0 E (O - E ) (O -E )1 (O -E )1

E

120 28 -8 64 2.286

50 38 12 144 3.789

30 34 -4 16 0.471

23 27 -4 16 0.593

35 35 0 0 0

i 35 31 4 16 0.516

TOTAL 7.655

4.10.3.2: Chi Square calculated 3

Chi Square = Sum (0 - E) 2= 7.655

E

Number of degrees of freedom = ( r - l ) ( c - l ) = l x 2 = 2

For two degrees of freedom at 5% significant the critical value for Chi Square = 5.991

The calculate value for x is greater than the critical value and hence our hypothesis we reject

the null and accept the alternative. We therefore conclude that the environment and

ergonomics have effects on health and safety practices in the private hospitals Mombasa

Island

4.10.4: Testing Hypothesis 4.

The 4th Hypothesis was testing on whether accidents influence health and safety practices

The hypotheses were stated as below:-

Ho: Accidents do not influence health and safety practices in the private hospitals.

Hi: Accidents influence health and safety practices in the private hospitals

\

\

52

OPINION NO. OF

RESPONDENT

Total

Pandya Aga

khan

Mombasa

Those who believe accidents 25 40 20 85

influence

Those who do not believe

accidents influence

30 33 45 108

TOTAL 55 73 65 193

Table No. 4.10.4.0: Opinion about accidents.

Based on the above data the expected frequencies were calculated as follows:

Opmion/Hospitals Those who believe

accidents influence

Those who do not

believe m accidents

influence

Total

Pandva 55/193x85=24 55/193x108=31 55

Aga Khan 73/193x85=32 73/193x108=41 73

Mombasa 65/193x85=29 65/193x108=36 65

Total 85 108 193

Table No. 4.10.4.1: The expected frequencies about influence on accidents.

53

Therefore:

o E (O -E ) ( O - E ) 5 CO - E)2

E

25 24 1 1 0.042

40 32 8 64 2.000

20 29 -1 1 0.035

30 31 1 1 0.032

! 33 41 -8 64 1.561

45 36 9 81 2.250

TOTAL 5.920

Table No. 4.10.4.2: Chi squared calculated 4

Chi Square = Sum CO - El2 =5.920

E

Number of degrees of freedom =(r - 1) (c - 1) = 1x2 = 2

The calculated value is less than critical value at 5% degrees of significant hence we reject

the null hypothesis and accept the alternative. Therefore accidents influence health and safety

practices in private hospitals.

\

54

CHAPTER FIVE

SUMMARY OF FINDINGS, DISCUSSION, CONCLUSION

AND RECOMMENDATION5.1 Introduction

The research was on the evaluation o f the Occupational health and safety practices at The

private Hospitals in Mombasa Island, to assess their impact on health and safety to the

workers well being and also to make appropriate recommendations based on findings. This

chapter centers on summarizing the findings, drawing conclusions and making

recommendations based on the researchers findings to qualify the significance of the study.

5.2 Summary of findings and Discussion

The findings were based on the objectives set out for the study and were found to be as

follows.

i. On the objective of establishing the extent to which legal requirements regarding

health and safety at work influence Occupational safety and health practices at the

hospitals it was found out that the majority of the respondents conquer that Health and

safety facilities like goggles, protective clothing, overalls gumboots, hand gloves are

adequate to cater and protect employees while carrying out their duties. However

there is need for the management to insist on using them. It was further observed that

the visitors handle patients in wards without any protection

ii. On the objective of establishing to extent to which management of health and safety

program and safety committees influence health and safety practices at the private

hospitals in Mombasa Island. There is no Health and Safety program in existence in

the private Hospitals in Mombasa Island to guide the management of those hospitals

in maintaining a Healthy and Safe work environment, and that majority of the

respondents do not know the standard of behavior expected of them in health and

safety matters

In addition it is evident from the research that the management lack clear strategies

and commitment to health and safety. The health o f staff and safety of the

environment was not viewed on as a matter of outmost importance and the health and

safety matters are neither communicated to staff. The hospitals do not have a safety

55

policy documents issued to all employees or a handbook which includes details of the

policy.

iii. On the objective of the establishing the extent to which working environment

influence health and safety practices at the private hospitals, the various factors of

ergonomics like lighting, ventilation, housekeeping etc are in normal add safe

conditions. There was adequate proper lighting, ventilation and the place was free

from noise.

iv. On the objective of establishing the extent to which health and safety education or

awareness influences health and safety practices in the private hospitals, it was

evident from the research that all respondents were literate, thus could read and

understand the health and safety rules and regulations, and were able to disseminate

information on issues relating to health and safety matters. It was further established

that the majority of the respondents have not undergone any training on Health and

safety matters, either through seminars, courses and workshops and that matters in

Health and safety are not either discussed in staff meetings. Safety training spells out

the rules and provides information on potential research and how to avoid them.

\. On the objective of establishing the extent to which accidents influence health and

safety practices in private hospitals it was observed that there was No regular

inspection on Hospital facilities carried out. No proper records are kept on accidents

to describe the nature o f accidents. This is aggravated by lack of investigation on the

causes o f such accidents.

5.3 Conclusion

In the forgoing study the researcher has established that accidents are aggravated by unsafe

acts, unsafe work conditions and human conditions. Unsafe acts include the failure of the

administration to train staff on issues relating to health and safety as well as inadequate safety

devices.

In addition there should be provision and maintenance of systems of work that are so far as is

reasonably practicable safe and without risks to health o f employees, provision of risk

information, instructions, training and supervision is necessary to ensure health and safety of

employees.

It should be noted that safety education and training is an important tool to reducing accidents

and diseases. This is only possible if the top management is committed and adequate

resources are provided to carry out the exercise.

56

Fmployees should be responsible to avoid injury to themselves or others and should co-

perate with the management in meeting the statutory requirements on health and safety.

Work environment should ensure roper communication channels and working conditions

since they have a direct effect on Human behaviour at work place. Reward system, skill

development and motivation should be well thought of and planned.

It is important also to improve poor relations and ensure that the management is able to

create team spirit that encourages the employees to work safety.

It was further noted that most accidents are caused by various forms of negligence and failure

to wear protective clothing or use of devices, lack of concentration. All these amount to poor

attitude towards safety. Working safely is habit forming and rapidly develops into group

pride in maintaining an accident free work place. Lack of training and experience also may

cause accidents

Finally unsafe acts can be reduced through proper selection and placement of employee in

safe practices.

5.4 Recommendations

The researcher, through the findings suggests that it is necessary to make safety training as

part of regular schedule in the private Hospitals in Mombasa Island. Continuous training on

Health and Safety practices should be conducted and recommendations imparted to

employees through seminars, workshops, meetings on the job training for new employees etc.

such training programmes should concentrate on pointing out various hazard and risk areas

and the importance of wearing protective clothing’s and use of safety devices with proper

supervision for reinforcement. The supervisor must try to discipline employees into observing

safety routines always on a personal protection.

The management should ensure that enough protective equipment, devices and clothing are

provided to employees to safeguard against hazard and ill health. The effectiveness of such

devices as goggles, hand gloves, boots etc depends upon the employee’s good sense and the

supervisors' watchfulness. The tendency to discard the protection often occurs; if it hampers

the work or if the employee. In other instances people simply forget and inevitably the lapse

conceded with an accidents, hence improving safety attitudes hinges upon human relations

and the supervisor ability to create team spirit that encourages employees to work safely.

57

i. The management should put in place procedures for identifying and eliminating

dangerous situations with adequate information on use of tools; equipment should be

disseminated to all employees.

ii. The management should encourage team spirit, delegation of decisions and designs

jobs to permit exercise o f responsibility for improved health and safety standards and

employ a safety representative and create a safety committee.

iii. Written rules and procedures should be spelt with consistent disciplinary system for

all violators.

iv. The management should ensure its commitment and integration of safety and health

concerns in planning. Management commitment to health and safety is a crucial

element.

v. The management should do proper job placement, set standards of health and safety

and be able to get feedback through appraised and recognizing their efforts. To do this

is should ensure a performance based safely and health policy with dear assignments

and responsibility, adequate resources together with employee involvement

vi. The administration should ensure arrangements are made to plan, organize, control,

monitor and review protective and preventive measures at work. Annual or periodic

evaluation of safety and health programs, corrective action plans and verification

procedures should be put in place.

vii. The management should establish a well maintained structure of responsibilities for

safety and health matters throughout the hospital premises.

viii. The management should provide appropriate training for employees both on

recruitment and when risk change.

In an nutshell the study has suggested improvement on the existing Occupational

health and safety programmes in place at The Private Hospitals in Mombasa Island,

hence with the recommendations, it is hoped that it will assist the management of

those hospitals.

5.5 Suggested areas for further research

The researcher further recommends that are risk assessments be carried out in all the private

hospitals so as to identify hazards and analyze the risks attached to them. In addition a similar

research be carried out in all government aided Hospitals.

58

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ARMSTRONG M. (2001). A Handbook of Human Resource Management Practices (8lh Edition - Iilogan Limited)

Bennet R. (1997). Management 3rd Edition Financial Times.

Betts P.W. (1983). Supervisory Management. 4lh Edition

Bhatt V.N. (1998). Total Quality Management. ISO 14000 Approach.

Burchill F. & Casey A. (1996). Human Resources Management (The NHS - A case study Macmillan business).

C. R. Kothari, Research Methodology, Methods and Techniques.

Cascio W.F. (1981) -Human Resource Management Virginia Reston Publishing Ltd.

COLE G. A (1999). Management Theory and Practice Letts Educational - London

Dankit K. Nassiuma. Survey, Sampling, Theory and Methods

Dessler G. (2000). Human Resource Management Practice,Hall Inc-New jersey

Donaild K. Kombo and Delno L. A. Tromp. Proposal and Thesis Writing.

Employment act cap 226 laws of Kenya - Government Printers (1999)

Factories and other places of work act cap 514 Laws o f Kenya - Government Printers

FLIPPO E.B. ( 1974). Principles o f Personnel Management.MC Grawhall

Graham H.T & Bennet R. (1998). Human Resource Management 9th Edition - Pitmans Publishing

Hall T.L. & Mpjia A (1978), Health and Manpower Planning Principles,Methods and issues (as Hoi Geneva)

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Nzuve S.N.M (1999). Management o f Human Resources, a Kenyan Perspective, Tech and Pro, Associate Publishers Ltd - London

Pratt R. J (1979). Elements of Personnel Management - London GEC and company Publishing Ltd.

Soraya M.C and Cynthia A. S. Proposal Writing 2nd Edition.

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Stranss G & Sayles L (1980). Personnel, The Human Problem of Management, 4th Edition - Practice Hall

Waweru E.M. (1984). Management of Human Resources in Kenya. Kenya Literature bureau

Waylor J. (1996). Operations Management. Pitman Publishing

60

APPENDIX 2

Questionnaire

Please fill in the information in the space provided

DEPARTMENT SECTION DESIGNATION

I. PERSONAL PARTICULARS

a. NAME..................................................................................

b. GENDER: MALE l ~ ~ | FEMALE [

c. AGE (Tick as appropriate)

1 8 -2 5

2 6 - 3 0

31 - 3 5

3 6 -4 0

41 - 4 5

4 6 - 5 0

51 55

d. Date o f appointment .....................................................

e. Marital status: Single I I Married I I Others [

f. Education level: Primary (1) I I Secondary (2) 1 — I

University (3) I 1 Others (4) 1 — I

g. If No. 4. please specify

2. Briefly state the duties and responsibilities assigned to you

61

3. Among the tasks you handle, which one do you consider harmful and risky?

4. (a) If risky, are you provided with protective equipment / devices?

Yes | | No | |

(b) If yes, are they adequate?

(c) If No, what suggestion can you make?

5. How would you describe your working environment? (Tick as appropriate)

Normal l I

Safe I I

Hot I 1

Fumed I I

Hazardous I I

6. Do you suffer from any work fatigue?

Yes czc No

7. Is there a Health and Safety policy / program in your institution?

Yes CUD No

8. a) Are there rules and regulations on health and safety practice at work place

communicated to you?

Yes |------- 1 No | — i

b) If yes, how are they communicated to you?

Always l ~1 Occasionally | | None | |

c) Explain how they are communicated to you.

62

9. a) Does the institution have health and safety committees?

Yes No [----1b) If yes, who are the members?

10. a) Have you attended a health and safety training course or seminar?

Yes i------- 1 No |------- 1

b) If yes, briefly state the contents o f the training

11. Is the hospital administrator committed to health and safety o f the staff?

Yes I------- 1 No I------- 1

12. Briefly explain how health and safety matters are handled in your institution?

13. How many incidents have you come across your place o f work?

14. Are you provided with a medical cover by health organization?

Yes | - | No * I

15. What role do you play in health and safety matters?

16. a) Has the administrators provided any welfare facilities for members of staff?

b) If yes, state which ones

63

APPENDIX 3

Interview guide for the administrators and department heads

1. Now that you have staff and patients, what health and safety measures have you put

in place?

2. How often do you discuss health and safety issues with your staff?

3. Do you have a health and safety policy in place?

4. What procedures and programs on health and safety have you put in place?

5. Do you organize training in health and safety measures for your staff?

6. Do you have a committee dealing with health and safety o f the employees?

7. What are the health benefits provided to employees?

8. Which criteria do you use to communicate health and safety matters to staff?

9. What role do you play in health and safety procedure within the institutiort?

10. What are some of the limitations you face in implementing the health and safety

program for staff under you?

11. What suggestion do you have to improve the existing health and safety o f staff?

64

APPENDIX 4

Observation Guide

The researcher intends to observe the following variables to guide carrying out the

study

Variables Remarks

1. Prohibitive precautionary measure

a. health and safety notices

b. Warning signs

c. Propaganda campaigns like posters, safety

and suggestion boxes

d. Accident reports

2. Procedures

a. Protective measures in place

b. X-ray procedures

c. Hospital waste disposal

d. Handling o f patients

3. Working environment

a. Ventilation

b. Sanitary conditions

c. House keeping standards

d. Lighting

e. Cleanliness

f. Floor

g. Fumes

1 ' ;V: i t * ,r-

U i X A R Y30197

’f f O B I

4. Condition of plants, tools and equipment

65

4

a. Adequate

b. Defective

c. In built safety

d. Types of protective equipment / Tools and

clothing

! 5. Welfare

a. Canteen

b. Security devices

c. First aid

6. Working conditions

! a. Shift working hours

b. Flexible working hours

c. Fixed working hours

•

6 6